In spring 2015, Jenny woke from surgery devastated to learn she had lost her baby as well as her ability to conceive naturally. She had experienced an ectopic pregnancy and required emergency surgery. The affected fallopian tube ruptured, and the other one filled with fluid, a condition called hydrosalpinx. Doctors had to remove both tubes but were, fortunately, able to save Jenny’s life.

Jenny and her husband were living in the Midwest at the time, but then moved to California where they started looking for fertility clinics. Recalled Jenny, “A friend gave us an ‘anti-recommendation’ for a clinic where they’d had a bad experience. But they knew people who’d had a great experience with Dr. John Norian at HRC Fertility and suggested we contact him.”

The couple attended one of HRC Fertility’s monthly seminars and met with Dr. Norian in May 2016. After their initial consultation, events progressed quickly. Jenny completed the paperwork, retrieved her medical records and underwent all the tests and prep work so the couple could start their first stimulation cycle a few months later.

The results weren’t initially encouraging, and Dr. Norian suspected Jenny had diminished ovarian reserve. She and her husband decided to wait and begin a new cycle after the doctor adapted her new medication regimen.

Dr. Norian made the necessary changes, which doubled the number of eggs and embryos Jenny produced. The lab also performed genetic testing (PGD) on the embryos, and Dr. Norian transferred the best embryo in November. Jenny became pregnant but tragically miscarried their little boy.

“Dr Norian was shocked the cycle hadn’t worked, but was also sympathetic, supportive and encouraging. I waited a few months for my body to rest, and our next cycle resulted in our beautiful baby girl. We traveled a long road to get her, but I finished treatment with Dr. Norian almost a year after we started.”

Jenny was grateful for the extra monitoring appointments HRC Fertility provided and she “graduated” at 10 weeks. When she had trouble getting an appointment with her OBGYN, Dr. Norian contacted an OBGYN he knew to get her seen earlier.

She said, “I was so appreciative of him going the extra mile and helping me transition my care.”

Jenny, who is a hospital chaplain with a theological background, is now able to reflect on all that she went through on her infertility journey. Though the treatment process was difficult and the outcome uncertain, she says that she always felt like Dr. Norian and his team were invested in their success.

As a chaplain, she also acknowledges being a patient is very different from counseling someone who has gone through miscarriage and loss. “It’s important not to compare your journey to anyone else’s and to choose hope over fear. Infertility may be a longer road than you think and, at times, it might take over your life. It’s important to take care of yourself and confide in others.”

Before moving to California, Maggie T. had undergone several surgeries in Colorado to repair a uterine septum preventing her from getting pregnant. It was a traumatic experience, with Maggie needing to find a second surgeon to correct the errors the first doctor made.

At the urging of her then boyfriend (now husband), Maggie quit her job and moved to California where she focused on getting herself into shape and finding an infertility physician.

She scoured the Internet and was impressed with Dr. David Tourgeman’s online reviews. But she didn’t stop her search there. She dug deeper to learn how his patients honestly felt about the care he administered.

Recalled Maggie, “By the time I had my initial consultation with Dr. Tourgeman, I’d been through the ringer with the first fertility practice. That doctor did not understand my infertility issues, and the staff did not support me emotionally. After several surgeries and one unsuccessful round of IVF, I wanted to make sure a new clinic and doctor would not repeat the same mistakes.”

The former program manager was direct with Dr. Tourgeman about her needs, and was pleasantly surprised to learn that HRC Fertility was committed to not only treating patients medically but also supporting them emotionally. “Deciding to become Dr. Tourgeman’s patient was one of my best decisions,” she said. “He read all my charts to understand what was wrong with me. He also adjusted my medications after assessing what my previous doctor had done. I feel all the new steps he took contributed to my success with IVF after one cycle. Above all, he was upfront and honest. I knew exactly what to expect.”

Maggie and her husband also appreciated how kind and courteous every staff member in the office was; everyone knew her name, from the nurses to the front desk employees. She never felt like a number or that the clinic could not make time for her individual needs.

Most importantly, Dr. Tourgeman saw her at every appointment and was with her every step of the way. “He completely changed my perspective. I felt jaded from my previous episode with the Colorado practice and was resigned to the possibility we might not be able to have kids.”

Though her focus is now her infant daughter, Maggie eventually would like to take what she has learned from her fertility journey and help other women who are confused and concerned when they can’t conceive.

“It can be so frustrating when you can’t get pregnant,” added Maggie. “No one knows how to start the process of finding the right infertility doctor.” She advises couples to spend the necessary time to find the right doctor who will be an advocate and engaged in their care: “Don’t rely on one source to look for a doctor. Do a thorough Internet search and ask other people for referrals. The best doctor for you is not necessarily the one with the best success rates on paper, but is the provider who is going to listen and work on your behalf.”

Whether you’re undergoing intrauterine (IUI) or in vitro fertilization (IVF), an infertility treatment cycle consists of many steps. Everyone involved in the process — doctors, nurses, embryologists and patients — does their part to ensure the cycle will be as successful as possible. Then the waiting begins, euphemistically known in the “trying to conceive” world as the tortuous two-week wait.

At HRC Fertility, we try to support our patients and their partners as much as possible during this emotionally turbulent time. The emotional roller coaster doesn’t necessarily end with the announcement of the first test results and often continues throughout the several months before we discharge patients to their obstetricians.

For most infertility patients, a pregnancy test is not as simple as seeing two lines on a home pregnancy test (HPT). They will undergo several blood hormone tests as well as ultrasounds to confirm the health of their pregnancy.

Initial beta hCG blood test
We will administer the initial blood test, known as a beta hCG, 12-14 days after an IUI or embryo transfer. It will assess the presence of human chorionic gonadotropin (hCG), which is produced by placental cells that nourish the fertilized egg after it becomes attached to the uterine wall.

It takes about two weeks for the test to determine if the embryo is creating a sufficient amount of new hCG versus the hCG that can linger in our body after it is administered as the ovulation trigger shot. Because of this, we need to wait an adequate amount of time to ensure patients do not get a false positive.

Even though those weeks may seem like an eternity, blood tests can detect the presence of hCG earlier than commercially sold urine tests, which require you to wait until you have missed a period in order to obtain an accurate outcome. We advise patients to be patient and avoid taking a home pregnancy test.

Congratulations, you are pregnant!
When the day finally arrives to learn your test results, you will likely be on pins and needles. A positive result is considered above 25mIU/ml.

As your pregnancy progresses, hCG levels typically double every 72 hours, confirmed by blood tests over the next several days.

Your hCG levels will reach their peak in the first eight to 11 weeks of pregnancy. Repeat blood tests should be performed by the same laboratory so results are consistent. After several hCG beta blood tests with increasing levels of between 1000-2000 mIU/ml, we will order one or two ultrasounds to look for the presence of an amniotic sac and a heartbeat. Around 8 to 10 weeks, we will feel confident to discharge you to the care of your OBGYN for further prenatal care.

This transition period can be equally stressful, especially for those who have experienced previous IVF failures or miscarriages.

If your results are negative
Though we were hoping to tell you good news, this, unfortunately, is not always the case. Before you start a cycle or at the embryo transfer, we try to be candid about your prognosis. If we find that you’re not pregnant, we will do our best to communicate this news to you in the most sensitive way possible, as well as be available to answer your questions. We will schedule you for a follow-up appointment where we can discuss what we learned from this cycle and how we suggest you move forward. Though delivering bad news is never easy, we are committed to supporting you every step of the way.

Additionally, you could experience a chemical pregnancy, where beta hCG levels at first rise appropriately, but we cannot confirm the pregnancy at the ultrasound. This is devastating news, though hopefully we can glean some information about what caused the implantation failure, whether it’s a chromosomal abnormality or issues with the uterine lining, which can be used to fine-tune your next cycle.

We will also observe your results for indications of an ectopic or molar pregnancy.

Knowing what to expect in the testing process can be very empowering. Though we cannot guarantee a positive outcome for every treatment cycle, we can assure you that we will provide all the information and support you need to survive the two-week wait, the results of your pregnancy tests and your transition to an OBGYN.

Mary and James had been trying to conceive for eight years before being referred by their OBGYN to HRC and Dr. Bradford Kolb. The couple had seen other infertility specialists, including one overseas, and had undergone unsuccessful IUI and IVF cycles plus a heartbreaking ectopic pregnancy.

By the time they first saw Dr. Kolb in fall 2015, they were considering surrogacy. “We thought our age was a factor, “recalled 42-year-old Mary. “But Dr. Kolb reviewed our records and ran some tests. He convinced us that everything looked good and was confident we could get pregnant with IVF.”

The couple really liked how Dr. Kolb took the time to listen and was hands on, which was a pleasant departure from their previous physicians. One doctor would only see them a few minutes before handing them off to the staff. They also liked that Dr. Kolb was receptive to Chinese acupuncture, which made them feel less stressful and more relaxed.

At HRC Fertility, Mary and James underwent two cycles of IVF and had their embryos genetically tested. The remaining viable one became their son, who was born in June. They thank their lucky stars for this gift.

Mary advises other couples to do their homework to see if prospective clinics are a good fit for their needs and personality. They also encourage others to have a game plan, as they did. Mary explained, “We felt stressed during our previous IVF cycles. During our last one at HRC, we felt comforted knowing we had a backup plan if it didn’t work. That really helped to reduce our stress levels.

Even though they weathered much disappointment with other fertility providers, Mary and James are grateful for having found Dr. Kolb, knowing he was the difference in helping them create their family.

Jill and her husband had been trying to start a family for several years when she sought help from her gynecologist because of abnormal menstrual bleeding. Her doctor suspected she had PCOS, but also diagnosed her with complex hyperplasia with atypia, which usually is found in childless women undergoing menopause. At 31, Jill learned she needed to be treated for this precancerous condition before she could start fertility treatment.

Once she was given the go ahead, Jill began treatment in 2016. Her doctor referred her to Dr. David Tourgeman along with other fertility specialists. “We really wanted to ‘click’ with our doctor,” recalled Jill. “Once I talked to Dr. Tourgeman, I knew he was the right choice for us.”

Because of her history, Dr. Tourgeman recommended the couple start IVF immediately. Unfortunately, their first two cycles were not successful, including a frozen embryo transfer that ended in miscarriage. But their third time with a fresh transfer was the charm and Jill became pregnant with twins. Zoe and Liam were born healthy and full term at 38 weeks.

Jill and her husband appreciated the support Dr. Tourgeman and his staff gave the couple both before and after they conceived. Said Jill, “I liked how he adjusted the medication protocol after each cycle. He was open to all of my suggestions, and his nurses were always very responsive. After we got pregnant, he was still supportive and interested in how we were doing. I’ve heard that not all fertility doctors are like that.”

Jill also took advantage of a fertility acupuncturist and other HRC services, including a medication administration service, that helped her have an easier, more relaxed experience.

“Infertility is not a fun journey, but it’s worth everything in the end. At first, you feel ashamed and wonder why you can’t get pregnant. Once you start being open about your infertility, however, you are amazed at how many people are having the exact same struggles as you, and you don’t feel so alone. We always felt our path was to try plan A, but if it didn’t work, we would move on to Plan B.”

As the parents of newborn twins, Jill and her husband are basking in the delights of their Plan A.